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PubMed1975

Microtubules in thyroidectomy cells of the rat anterior pituitary gland.

Microtubules were successfully illustrated in thyrotrophs and thyroidectomy cells of rat pituitary glands. In contrast, microfilaments were mostly seen in the nonglandular follicular cells. Numerous microtubules were observed in the early stages of development of the thyroidectomy cells. In thyroidectomy cells microtubules were located in close proximity to mitochondria, endoplasmic reticula, secretory granules, and membranes of Golgi complexes. Consequently, it is suggested that microtubules may play a role in degranulation or other processes associated with the hypersecretory state.

Animals↗
PubMedDate not supplied

Post-thyroidectomy metastatic thyroid cancer.

BACKGROUND: The objective of this paper is to highlight the importance of tissue biopsy for histopathological diagnosis. METHOD: A report of a 46-year-old farmer with post-thyroidectomy metastatic thyroid cancer. RESULT: A post-thyroidectomy patient presenting with extensive skull and lumbar spine metastasis, paraparesis, huge occipital swelling and good healed scar without tumour residue. The thyroidectomy specimen was not subjected to histopathological diagnosis. Fine needle aspiration cytology of the occipital swelling revealed metastatic follicular carcinoma. Patient was placed on thyroxine 0.5mg daily with great improvement of lower limb muscle power. CONCLUSION: These bony metastases could have been reduced if proper investigation was done. There is need for continuous medical education for all clinical medical personnel.

Adult↗
PubMed1999

[Prophylactic total thyroidectomy in childhood for multiple endocrine neoplasia type 2A: preliminary results].

OBJECTIVE: Evaluation of prophylactic total thyroidectomy in childhood in case of MEN2A gene carriership. DESIGN: Retrospective. METHOD: Prophylactic thyroidectomy was performed in 14 MEN2A gene carriers (7 boys, 7 girls; median age 9.1 year (range: 4.8-14.7)), in June 1993-July 1997 at the department Pediatric Surgery of the Wilhelmina Children's Hospital in Utrecht, the Netherlands. Median time between genetic investigation and operation was 5.5 months (range: 2-35). Lymph node dissection was not performed. The parathyroids were identified and left untouched as far as possible, autotransplantation was performed twice because of doubt about viability. Outpatient follow-up took place every 3-6 months. RESULTS: One patient (13.4 year) showed macroscopic, the other 13 microscopic multifocal medullary thyroid carcinoma, 11 bilateral and 3 unilateral. In 1 child (6.2 year) neuroinvasive growth existed already. Surgical sections were free of tumour. After the operation temporary hoarseness occurred once, temporary hypocalcaemia three times and permanent hypoparathyroidism twice; after autotransplantation no hypocalcaemia occurred. Median follow-up was 3.2 year (range: 1 month-4.0 year). Mild psychological problems were observed in 4 patients, psychiatric problems in 1. CONCLUSION: Prophylactic total thyroidectomy during the first decade is recommended. Additional lymph node dissection and total parathyroidectomy are unnecessary than. In order to prevent postoperative hypoparathyroidism, autotransplantation of at least one parathyroid is advisable.

Adolescent↗
PubMed1999

[Value of a single low-pressure drain in the postoperative care of bilateral thyroidectomies. Retrospective comparison with bilateral Redon drains].

Double "high vacuum drains" are usually recommended following bilateral thyroidectomy. A single "low vacuum drain" is an attractive alternative when the surgeon considers drainage is necessary. This retrospective study was designed to compare the postoperative outcome following the use of two types of drains. The clinical features, biochemical profile and histopathology were comparable between the two groups: group 1 (high vacuum, n = 77), and group 2 (low vacuum, n = 71). The percentage of total thyroidectomies was significantly higher in group 2 (51% versus 34%, p = 0.04) and this discrepancy was adjusted in the statistical analysis. There was no statistical difference in the outcome of group 1 versus group 2 in terms of wound infections (0% vs 0%), haematoma (0% versus 0.04%), duration and volume of drainage (2.1 versus 2.0 days, 118 versus 117 ml), and hospital stay (3.2 versus 3.2 days). A single "low vacuum drain" is therefore a safe and simple alternative to provide adequate post operative drainage following bilateral thyroidectomy.

Adolescent↗
PubMed1999

Follicular or Hürthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy?

BACKGROUND: Fine-needle aspiration biopsy (FNAB) and frozen section exam are of limited or no value in distinguishing benign and malignant follicular or Hürthle cell neoplasms of the thyroid gland. METHODS: Patients who underwent thyroidectomy for treatment of a follicular or Hürthle cell neoplasm between 1990 and 1998 were identified and evaluated for age, gender, head and neck irradiation, nodule size, and cytologic atypia to determine whether clinical factors were predictive of carcinoma. RESULTS: Of the 352 patients evaluated for nodular thyroid disease, 75 (21%) underwent thyroidectomy after an indeterminate FNAB finding, 66 with follicular and 9 with a Hürthle cell neoplasm. Seventeen (23%) of the patients had carcinoma-follicular variant of papillary (10), follicular (6), and Hürthle cell (1). Carcinoma was diagnosed in 15 of 64 women and 2 of 11 men (P > .05). The mean age was 43 +/- 21 years and 50 +/- 16 years, respectively, in patients with and without carcinoma (P > . 05). Three patients had previous neck irradiation and none had carcinoma. Mean nodule size was 4.2 +/- 2.7 cm and 4.3 +/- 3.5 cm, respectively, in patients with and without carcinoma (P > . 05). Cytologic atypia was present in 8 of 17 patients with carcinoma and 20 of 58 patients without carcinoma (P > .05). CONCLUSIONS: Clinical factors were not helpful in predicting carcinoma in patients with an indeterminate FNAB finding and thus cannot be used to reliably select patients for more extensive thyroidectomy.

Adenocarcinoma↗
PubMed2000

The effect of clinical pathway implementation on total hospital costs for thyroidectomy and parathyroidectomy patients.

Clinical pathways have long been used to guide the delivery of patient care in varied practice settings. There is little information in the literature to document the effectiveness of pathway implementation in general surgical populations. This study reports the effect of clinical pathway implementation in two general surgical patient groups, thyroidectomy and parathyroidectomy. Clinical pathways were implemented to serve patients undergoing thyroidectomy and parathyroidectomy surgery. The effects of both clinical pathways on total hospital costs, length of hospitalization, variances, and outcomes were collected and evaluated from July 1998 through July 1999. These data were compared to data from the previous year. The average length of stay for parathyroidectomy patients decreased from 2.4 to 1.5 days (P = 0.26) for pathway patients as compared to prepathway patients. The average cost per case decreased from $5071 to $4291 (P = 0.50) for parathyroidectomy pathway versus prepathway patients. The average length of stay decrease for thyroidectomy patients was 1.4 to 1.2 (P = 0.16) for the pathway to prepathway comparison. The average cost per case decrease was minor at $4117 to $4111. Pharmacy costs and laboratory utilization were effectively reduced. Perioperative costs rose dramatically during this period, operating room/central sterile supply cost per case rose 12 per cent, anesthesia supply cost per case rose 15 per cent, and surgical pathology costs increased 110 per cent overall for both patient groups. Clinical pathway implementation has allowed us to reduce or maintain total hospital costs in the face of rising perioperative costs. We conclude that implementation of these clinical pathways has allowed us to improve consistency with which we deliver care while maintaining the quality of patient outcomes and reducing the costs of care and length of hospital stay.

Adolescent↗
PubMedDate not supplied

Post-thyroidectomy hypocalcemia and feasibility of short-stay thyroid surgery.

AIM: To study the feasibility of thyroid surgery in a short-stay hospitalization regimen, with particular reference to postoperative hypocalcemia. METHODS: The clinical files of 696 patients operated on from January 1977 to January 2000 for thyroid diseases were analyzed. They were divided into groups on the basis of extent of operation and type of disease. Hypocalcemia incidence was compared between the different groups of patients. Data were analyzed statistically using the chi-square and Fisher's exact tests. RESULTS: There were 74 temporary (10.6%) and 12 (1.7%) persistent hypocalcemia cases. None of these occurred in patients undergoing lobectomy. The incidence of hypocalcemia was higher in two-lobe vs. single-lobe operations (p < 0.05), in total thyroidectomy with lymphadenectomy vs. total thyroidectomy (p < 0.05) and in hyperthyroidism vs. patients with normal serum hormone levels (p < 0.05). 84.9% of hypocalcemia cases developed on postoperative day 1, with only one tetanic crisis. CONCLUSIONS: Thyroid surgery in the short-stay hospitalization regimen is feasible for all patients undergoing lobectomy. Patients undergoing subtotal or total thyroidectomy may be treated in a short-stay regimen, only if they are affected with non-hyperfunctioning benign diseases and if they have normal serum calcium levels on postoperative day 1.

Adolescent↗
PubMedDate not supplied

Surgical treatment of multinodular goiter: incidence of lesions of the recurrent nerves after total thyroidectomy.

The problems concerning surgical goiter treatment are discussed, particularly the morbidity of total thyroidectomy and possible injury to recurrent nerves in comparison to the partial resection of the gland. We discuss our case material and review the literature. We conclude that total thyroidectomy seems to be the most effective surgical procedure with lower morbidity than subtotal thyroidectomy.

Adolescent↗
PubMed2001

Prophylactic total thyroidectomy in an 8-year-old girl with multiple endocrine neoplasia type 2A.

We report a genetic carrier of multiple endocrine neoplasia type 2A (MEN 2A) who underwent prophylactic total thyroidectomy. The asymptomatic carrier of MEN 2A, an 8-year-old Taiwanese girl, was admitted for early thyroidectomy. Preoperative basal plasma concentrations of calcitonin and intact parathyroid hormone, and urine vanillylmandelic acid excretion, were normal. Ultrasonography of the thyroid was also normal. Pathology did not reveal any gross lesion but C-cell hyperplasia of the thyroid gland was found microscopically. Prophylactic total thyroidectomy is encouraged and is justified during the first decade of life for MEN 2A carriers.

Child↗
PubMed2001

Parathyroid function in the early postoperative period after thyroidectomy.

Serum levels of parathyroid hormone (PTH) and calcium were studied in 132 patients, divided into three groups: unilateral thyroid-lobectomy, (sub)total thyroidectomy for non-toxic goitre and (sub)total thyroidectomy for hyperthyroidism. It was found that all types of thyroidectomy, even unilateral lobectomy, had a temporary influence on the PTH and calcium metabolism in the early postoperative period, albeit to different degrees. The effect was most pronounced after surgery for hyperthyroidism, which carries the greatest risk for postoperative hypocalcemia. The pathogenesis of transient postoperative hypocalcemia as well as the implications for the surgical management are discussed.

Adult↗
PubMed2001

[The influence of thyroidectomy of serum VEGF levels in patients with Graves disease].

Angiogenic cytokines, including vascular endothelial growth factor (VEGF), play an important role in patients after surgery because they facilitate proper wound healing. The aim of the paper was the comparison of serum VEGF levels in patients before and after thyroidectomy due to Graves disease (Gd). A serum VEGF level was determined by means of ELISA method before the operation as well as 3 and 7 days after it in 24 patients. The mean serum VEGF level was 61.2 pg/ml (range, 33.7-105.0 pg/ml) before the operation and increased after the operation to 115.6 pg/ml (range, 36.3-214.2 pg/ml). After thyroidectomy, the mean level of serum VEGF level in all patients rose by for 79.5% (range, 7.7-115.4%). These results suggest that serum VEGF level increases in patients with Gd after subtotal thyroidectomy, although disorder in secreting cytokines is observed in Gd patients and they were administered thyrostatics up to the operation, which have an immunosuppressive activity.

Adult↗
PubMedDate not supplied

[Prophylactic total thyroidectomy in children and adolescents with genetic mutations in the RET-protooncogene].

Medullary thyroid cancer (C.M.T.) can be a sporadic form generally in adults or a heredofamilial form where the first symptom appears in pediatric and adolescent age. The hereditary form can be isolated or associated with others endocrine neoplasias of type 2: MEN2a (with or without cutaneous lichen amyloidosis) and MEN2b. The responsible gene of the transmission has been identified in proto-oncogene RET localized on chromosome 10. Point form mutations of this proto-oncogene have been found on exons 10 and 11 in MEN2a and on 16 in MEN2b. In our study on 64 subjects, who belong 11 familiar groups, affected by MEN2a, MEN2b and familiar C.M.T., underwent a genetic research to look for point form mutations of proto-oncogene RET with PCR followed by the analysis of restriction. A genetic mutation has been revealed in 25 subjects: 18 were already known affected by MEN2 and so surgical treated and 7 seemed healthy (mean age 17.4 years, range 10-25). These 7 patients has been undergone clinical research and surgical treatment: a total thyroidectomy associated a lymphectomy of the central compartment. In all cases the histological exam showed C.M.T. moreover a patient had metastasis in lymph nodes of the central compartment. Another had hyperparathyroidism and pheochromocytoma treated with total thyroidectomy, parathyroidectomy and bilateral laparoscopic adrenalectomy. The identification in a very early age of carrier subjects of hill's gene inside an affected family, permits the execution of a prophylactic total thyroidectomy to prevent the C.M.T.. The penetrance of this neoplasia in hereditary form is 100%.

Adolescent↗
PubMed2002

Causes for early reintervention after thyroidectomy.

BACKGROUND: The purpose of our study was to ascertain the causes for early reintervention after thyroidectomy performed by a surgical team using a systematized surgical technique. MATERIAL/METHODS: We analyzed 1131 patients, 939 (83.1%) women and 192 (16.9%) men, average age 38.7 years (range 12 to 79). Of these patients, there were 675 hemithyroidectomies with isthmusectomy (59.74%), 189 subtotal thyroidectomies (16.71%), and 267 total thyroidectomies, alone or with regional lymphatic dissection at levels VI and VII (23.55%). Statistical analysis was performed by main tendency measures and chi square (chi-squared) for comparison of two independent samples; the dependent variable was the rate of early reintervention, while the independent variables included causes, time of presentation, hormonal functional state and extent of surgery. RESULTS: Early reintervention was necessary in 11 cases (0.97%). 9 were due to hematoma (0.79%) resolved with drainage and hemostasis, and two (0.18%) due to acute respiratory failure (ARF) caused by laryngeal edema, resolved by tracheostomy. Analysis based on diagnosis, extent of surgery and functional state failed to reveal statistically significant differences. The maximum time presentation of complications was 6 hours. CONCLUSIONS: The most intense postoperative monitoring is necessary during the first six hours. The low frequency of early reintervention and the appearance of complications in less than 8 hours enable thyroid surgery to be performed on a short-stay basis with adequate safety margins.

Adolescent↗
PubMedDate not supplied

Factors predicting outcome of hypocalcaemia following total thyroidectomy.

Postoperative hypocalcaemia is often observed after total thyroidectomy. In patients requiring calcium replacement therapy after 1 year, hypocalcaemia must be considered permanent. The aim of this study was to assess the incidence of hypocalcaemia following total thyroidectomy and to evaluate the risk factors predicting delayed outcome such as hypoparathyroidism. From January 1998 to September 2001, 310 patients underwent total thyroidectomy in our department. In a total of 37 patients experiencing hypocalcaemia, the authors carried out a comparative study of 34 patients with transient hypocalcaemia (group A) and 3 patients with permanent hypocalcaemia (group B). The incidences of transient and permanent hypocalcaemia were 11.9% and 0.9%, respectively. Central neck lymph-node dissection performed in cases of thyroid carcinoma correlated with permanent hypoparathyroidism. The most significant factors predicting long-term outcome of hypocalcaemia were low serum calcium levels (< 8 mg/dl) and high serum phosphorus levels (> 5 mg/dl) measured on postoperative day 7, despite oral calcium replacement. The indications for lymph-node dissection in the central neck area should be very strictly selected. When delayed serum calcium and phosphorus levels are unfavourable, thorough follow-up of patients is mandatory in order to administer the correct therapy and prevent the consequences of chronic hypocalcaemia.

Adult↗
PubMedDate not supplied

An easier technique for minimally invasive video-assisted thyroidectomy.

Because of the efforts of many pioneer surgeons, the minimally invasive video-assisted thyroidectomy (MIVAT) has been recognized as a safe procedure, offering advantages such as better cosmetic outcome and less analgesic need. The MIVAT technique was described in 51 selected patients in 2001. The technique was not therefore widely used because of the excess operating time compared with traditional thyroidectomy, and most importantly, this method needed a steep learning period. This study reports a modified MIVAT procedure, which can make this operation easier and shorten the time of learning. We compared the outcomes of the originally described methods with our modified method. The selection criteria for performing MIVAT were as follows: thyroid nodules in one lobe and less than 50 mm on their largest diameter, benign lesion proved by fine-needle biopsy, patient without history of thyroiditis, and no previous neck surgery or irradiation. All patients received lobectomy. Sixty patients were eligible for MIVAT during a period of 27 months. The patients were divided into two groups. Group A consisted of the 17 patients who underwent MIVAT using the original technique that was described previously. Group B consisted of the 43 patients who underwent MIVAT using a self-designed Army retractor with a mosaic ring. The mean operation time of Group A was 120 minutes and that of Group B was 59.2 minutes. The size of the incisions was no difference in either group. There were no postoperative complications except in one patient with transient recurrent laryngeal nerve palsy in Group A. There was one conversion to open thyroidectomy in Group A and none in Group B. The cosmetic results were no different between the two groups. In conclusion, the use of a modified Army retractor with a mosaic ring made the MIVAT procedure easier and offered similar advantages.

Adolescent↗
PubMedDate not supplied

[Nontoxic multinodular goiter: evaluation of recurrence rate and function after partial thyroidectomy. Retrospective analysis of 39 cases].

The postoperative goiter recurrence and hypophysial-thyroid function in 39 patients who underwent partial thyroidectomy for nontoxic multinodular goiter, during the 1970-1983 period, was evaluated, seeking relations among thyroid function, extension of surgery and goiter recurrence. The incidence of recurrent goiter was approximately 15%, most of these goiters having been identified ten or more years after thyroidectomy. More extensive surgery lowered the recurrence rate but increased the risk of subclinical-hypothyroidism. No statistical significant differences with regard to serum T3, T4, F T4 and TSH (basal and after TRH) of patients with and without recurrent goiter were found. Thus, the maintenance of a recurrent nontoxic goiter does not seem to depend exclusively on increased serum TSH levels. In one patient, the postoperative treatment with thyroxine did not prevent the appearance of recurrent goiter. Since most patients who underwent thyroidectomy remain euthyroid and the goiter recurs in only a small number, the routine postoperative use of thyroid hormone for the prophylaxis of multinodular goiter recurrence seems to be questionable.

Adolescent↗
PubMedDate not supplied

[Minimally invasive video-assisted thyroidectomy--techniques and results over 4 years of experience (1999-2002)].

INTRODUCTION: This study reviews four years of Minimally Invasive Video Assisted Thyroidectomy (MIVAT) technique and compares the results to those of traditional thyroid surgery. MATERIALS AND METHODS: Between 1999 and 2002, a series of 427 patients were submitted to MIVAT at our Department. Selection criteria were: thyroid nodule maximum diameter of 3.5 cm, total thyroid volume under 25 cc, no signs associated thyroiditis, diagnosis of benign thyroid disease or "low risk" thyroid tumor, no evidence of nodal disease of the neck. RESULTS: We operated on 362 females and 65 males and the mean age of the population was 39.6 years (range 10-77). A total thyroidectomy was performed in 208 cases, and 219 patients underwent a single-side procedure. Mean operative time was 30.4 minutes for lobectomy (range 20-140 minutes) and 50.2 for total thyroidectomy (range 35-140). Complications were represented by definitive recurrent nerve palsy in 3 patients (0.7%) and one case of definitive hypoparathyroidism (0.4%). A wound infection is reported in 3 cases and we had no major bleeding that required surgical revision. A conversion to open procedure was performed in 5 cases (1.2%); mean hospitalisation was 1.28 days (range: 1-4). CONCLUSIONS: This series demonstrates that MIVAT is not different to conventional open surgery in terms of complications, radicality of the procedure and operative time. Moreover, even if not statistically proved, MIVAT appears to offer some advantages in terms of cosmetic results and postoperative pain. In conclusion, we believe that MIVAT is a perfectly reproducible and safe technique for both benign and low-risk malignant thyroid disease, when correct indications are strictly followed.

Adolescent↗